Objective To investigate the application value of robotic‑assisted surgery for pancreatic cancer after neoadjuvant chemotherapy (NAT).

Methods The retrospective and descrip-tive study was conducted. The clinicopathological data of 10 pancreatic cancer patients who underwent robotic‑assisted surgery after NAT at The First Affiliated Hospital of Sun Yat‑sen University from November 2021 to January 2025 were collected. There were 7 male and 3 female, aged (62±7)years. Observation indicators: (1) NAT conditions; (2) intraoperative conditions; (3) postoperative condi-tions; (4) follow‑up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. The Kaplan‑Meier method was used to calculate survival time.

Results (1) NAT conditions. Of the 10 patients, 4 cases had tumor surrounding the portal vein or superior mesenteric vein more than 180° (no invasion of superior mesenteric artery), 3 cases had concomitant hepatic oligometastasis, and 3 cases had tumor invasion of adjacent organ (2 cases with tumor invasion of left kidney, 1 case with tumor invasion of duodenum). Nine of the 10 patients received chemotherapy of gemcitabine+albumin‑paclitaxel, and the other 1 patient received chemo-therapy of fluorouracil + irinotecan + oxaliplatin. After treatment, 3 patients were evaluated as partial remission and 7 patients were evaluated as stable disease. (2) Intraoperative conditions. Of the 10 patients, 5 cases received robotic‑assisted pancreatoduodenectomy and 5 cases received robotic-assisted radical antegrade modular pancreatosplenectomy, with no case converted to open surgery. There were 3 cases receiving combined vascular resection and reconstruction, including 2 cases with portal vein resection plus side wall repairing and 1 case with superior mesenteric vein resection plus end to end anastomosis. There were 2 cases receiving combined other organ resection intra-operatively, including 1 case with local hepatectomy and 1 case with left nephrectomy. The operation time of 10 patients was 465(range, 195‒565)minutes, volume of intraoperative blood loss was 70(range, 20‒350)mL. One case with preoperative anemia required red blood cell transfusion during the operation, while the other cases did not receive any transfusion during the operation. All 10 patients achieved R₀ resection and the number of lymph node dissected was 12±8. Three patients who underwent combined vascular resection and reconstruction had negative margin of the portal vein or superior mesenteric vein. (3) Postoperative conditions. Duration of postoperative hospital stay of 10 patients was (15±8)days, and 1 case developed major complications in grade Ⅲa of Clavein-Dindo classfication. Of the 10 patients, 1 case developed grade B pancreatic fistula, 1 case experienced delayed gastric emptying, and no case had postoperative biliary fistula, chyle leakage, abdominal or anastomotic bleeding, no case underwent reoperation, no case died within postoperative 30 days. (4) Follow‑up. All 10 patients were followed up after surgery for 10.0(range, 2.7‒40.4)months. All 10 patients underwent postoperative adjuvant chemotherapy, and the time from surgery to the start of adjuvant chemotherapy was (40±12)days. The median overall survival time of 10 patients was 30.4 months, and the median recurrence‑free survival time was 10.9 months.

Conclusion Robotic-assisted surgery can be used for pancreatic cancer after neoadjuvant chemotherapy.